Abstract
ObjectiveRecent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior.DesignAn exploratory cross-sectional study.Setting and participantsPrimary care physicians of the French-speaking part of Switzerland.Main outcome measuresPrimary care physicians’ perceived usefulness of each conventional and complementary medicine treatment and their reported recommendation behavior were considered dependent variables in multivariate logistic regression models. All correlations were computed between binary variables, and phi coefficients were calculated to estimate correlation strengths.Results533 primary care physicians answered the questionnaire (response rate: 25.6%). The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional treatments were physiotherapy (99.2%), nonsteroidal anti-inflammatory drugs (97.4%), and acetaminophen (94.4%). Osteopathic treatment (78.4%), yoga (69.3%), and therapeutic massage (63.9%) were the complementary medicine treatments most often considered useful by primary care physicians in managing chronic or recurrent low back pain. Being a female physician, younger than 56 years, trained in complementary medicine, or using complementary medicine were all associated with higher perceived usefulness of complementary medicine treatments in general. The most recommended complementary medicine treatments by primary care physicians were osteopathic treatment (87.3%), acupuncture (69.3%), and therapeutic massage (58.7%). Being a female physician, younger than 56, and using complementary medicine were all associated with more complementary medicine recommendation in general.ConclusionOur results highlight the importance of better understanding the prescribing patterns of primary care physicians for chronic or recurrent low back pain. Considering the frequency and burden of chronic or recurrent low back pain, programs focusing on the most (cost-) effective treatments should be implemented.
Highlights
Chronic low back pain is a common condition, with a global prevalence situated around 20% [1]
The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional
The number of primary care physicians (PCPs) registered in the local medical societies (n = 2443) differed from those registered in from the Swiss Medical Association (FMH) (n = 1757) for 2 possible reasons: there were a high number of false addresses among the local medical societies; and the FMH data included PCPs working outside hospitals only, whereas the data from the local medical societies included PCPs working inside hospitals
Summary
Chronic low back pain is a common condition, with a global prevalence situated around 20% [1]. Conventional treatment options for chronic or recurrent LBP include drug therapies, nonmedical interventions, and surgery [3]. According to a recent systematic review and meta-analysis including 35 randomized placebo-controlled trials, non-steroidal anti-inflammatory drugs (NSAIDs) reduced pain and disability in the immediate and short-term, but did not have clinically important effects on pain intensity [4]. Another systematic review and meta-analysis showed a short-term effect on pain, but the effect was small and probably not clinically relevant [5]. When it comes to non-pharmacologic interventions, exercise therapy reduced pain intensity and disability better than usual care and behavioral therapies had an effect on pain intensity [6]. Some studies suggest that CM non-pharmacologic therapies such as acupuncture [7,8,9], yoga [10, 11], Tai-Chi [12], Mindfulness-based stress reduction [13], osteopathy [14] and hypnosis [15] might be useful treatment options for patients suffering from chronic LBP [16], more studies are needed
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